What drug options do I have for arthritis?

A fellow caregiver asked...

I have chronic diseases and my worse pain is arthritis. I have a pain management doctor and therapist, both who are trying to find a happy medium. I have good days and bad days. with the pain from body somedays are not good and then there are good days. I have polymyalgia rheumatica, rheumatoid arthritis and osteo-arthritis. I take five medications (prednisone, methotrexate, enbrel injections, folic acid and hydroxychloroquine). The pain medicine is vicdon. I am 71 years of age. I also have hip problems, which I tolerate. So I was wondering are there any other medications that could work for me?

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Unfortunately, you have developed chronic pain from your trio of arthritis syndromes. Polymyalgia Rheumatica (PMR) frequently causes pain and stiffness in the shoulders and hips. This syndrome will often improve with the use of prednisone alone, so this is probably not what is causing alot of your pain at this point. My guess is that your pain is really from osteoarthritis and rheumatoid arthritis, since these types of arthritis can be more difficult to treat.

You have listed your medications, and they are all commonly used in these types of arthritis. But any clinician will tell you that medications are only half of the job in reducing chronic pain. You should also be doing the following:

1) Keep yourself mobile and active, since this will help preserve joint mobility and increase your muscle strength. Often, physical and occupational therapy can help establish exercises, even during periods of pain, to keep you mobile.

2) You should be using hot or cold compresses (whatever feels better) to reduce pain.

3) Periods of rest are critical for your body. This allows your body has time to recover from inflammation from these diseases. Most experts recommend 2 hours of rest daily for days with mild pain, increasing rest during periods of more pain.

4) Use yoga or stretching to help increase flexibility (gently) and reduce stress.

5) Lose weight if you are overweight, as this will decrease the wear and tear on your joints.

You asked about other medications that can help pain. Other pain medications I have tried include: 1) Antidepressants (which are quite effective, since chronic pain does change your brain chemistry) 2) Tylenol or motrin. Check with your doctor before adding these, as you might take too much tylenol (it is in Vicodin), and Prednisone with Motrin can increase stomach irritation.

3) Long-acting opiods

4) Seizure medications, as these are good for nerve pain.

You can also use topical creams like Ben Gay, aspercreme, or Capsacin to see if they help you. For osteoarthritis, they can do steriod injections of the specific joints that are painful to try and reduce the inflammation there. I would encourage you to look for a support group for chronic pain sufferers at your local senior center, as other folks who live with chronic pain may offer you even more advice.